The Health Bill – Good or bad for northern England?

Emergency time. How will decisions made in London affect the north? Photograph: Frank Baron/Guardian

It used to be said that the most difficult job in British politics was that of leader of the opposition – a role in which you can talk and talk like there's no tomorrow but can't actually do anything. I would argue that perhaps right now, Health Secretary, Andrew Lansley may be feeling that same sense of helplessness, buffeted about as he has been by events beyond his control.

Since he first took the health brief for the Conservatives in opposition in 2004, Lansley, together with David Cameron, has made it a mission to detoxify the party's image on the NHS and re-establish the public's trust in the party to manage one of, if not the, most treasured institution in the UK. In opposition the mantra was "NHYes", solidifying the Prime Minister's assertion before the general election that the health service would be his party's number one priority.

Fast forward two years, and Ministers must now be scratching their heads about what has gone wrong. Having introduced a Health and Social Care Bill which required the pause button to be pressed to respond to mounting criticisms from health professionals about its likely impact, it is becoming increasingly difficult to find anyone prepared openly to declare their support.

If it were just Shadow Health Secretary, Andy Burnham's declaration that the Government faces the fight of its life over the Bill, then I suspect Andrew Lansley would be sleeping well at night. But it's not. Its far more than that, and the Health Secretary knows it.

Having spent such political capital gaining the trust of the NHS establishment, the sight of opposition or doubts from almost every major medical and health body, representing everything from nurses to doctors, psychiatrists to porters, and patients to surgeons, shows that the Government is in a fix. And just this week research published in the Lancet health journal has seemingly contradicted Andrew Lansley's claims that productivity in the NHS under Labour had fallen, whilst internal reports for the NHS have pointed to the risks the Bill could pose. In relation to northern England, the Guardian's Political Correspondent , Juliette Jowit this week wrote:

According to the report for the north of England, risks rated 15 or higher are considered "significant" and coded in red; those from 8 to 12 are judged "high" or amber risk. In the north of England officials warn the risk of achieving "productivity gains at the expense of quality", defined as "safety, clinical effectiveness and patient experience", rates as 12 – a possible event with major impact – even after the mitigation actions so far chosen are taken.

The same report warns of a similarly high risk of "organisational and system instability" damaging management and governance, and uncertainty caused by the changes that could reduce the capacity and capability of staff and organisations.

Lower rated problems – still considered high risks – cover a wide range, again after existing mitigation, including a "loss of grip on current performance", that "safety is compromised by lack of clarity on accountability, poor morale, and loss of knowledge", that the benefits of the reforms are not achieved, and there is a loss of public confidence in the NHS.

Difficult times for the Health Secretary, yet none of these compare to the ultimate political headaches he now has. Firstly, a growing sense of unease from both sides of the governing coalition about the way things have been handled with the deputy leader of the Lib Dems, Simon Hughes, making quite clear over the weekend his belief that Lansley should go once the reforms have been passed. And more damaging still, the revelations on the influential grassroots website, Conservative Home in a piece by its editor, Tim Montgomerie, that three cabinet minister shave "rung alarm bells" over the electoral damage of proceeding with the Bill in its current state.

And it is that very issue that is causing the Government so many problems. It is one thing batting criticisms off from organised health service groups as "vested interests", but on an issue as sensitive as the NHS, as soon as the public lose confidence in a reform, then Governments have problems. And nowhere have those concerns been expressed more strongly than in northern England.

A recent YouGov poll for the Sunday Times, showed that when we take out Scotland which will not be affected by the changes, northern England is the most sceptical region when it comes to the debate over the Health Bill. Just 19% of respondents in the region expressed support for the proposals compared with 58% who outright opposed. 53% argued that greater competition within the NHS would cause services to get worse whilst 55% called for the reforms to be dropped completely. Indeed, even with Labour supporting the idea of GP commissioning, 49% of respondents to the poll in northern England believed that giving greater control to GPs over the way money is spent in the health service would make services worse.

With an e-petition calling for the Health Bill to be dropped altogether having exceeded the 100,000 names needed for it to be automatically considered for debate on the floor of the House of Commons, as MPs return to Westminster next week the headaches will continue for Andrew Lansley.

It is against this background that two of the leading figures on either side of the debate go head to head on the Guardian Northerner today.

For Labour, its Shadow Health Minister, Andrew Gwynne argues that the reforms being proposed within the bill will simply bring to an end the NHS as we know it, calling for Minister's to drop the bill entirely.

Writing for the Government, health minister Simon Burns points to the reforms within the Bill as being vital to ensuring the NHS can respond to the ever changing demands being placed on it, arguing:

With the NHS everywhere in the country facing the challenges of an ageing population and the rising costs of treatments and technologies, this extra funding alone will not be enough to safeguard the NHS for future generations. That is why, with the additional money, reform is also needed.

What do you think? Should the bill be dropped or are the reforms proposed by the Government vital to the future health of the NHS?